Certified Practice: DST Update | Remote Nursing

The CRNBC certified practice decision support tools (DSTs) undergo a regular review to ensure they reflect current evidence for the certified practice areas. The process includes a systematic review and update by clinical experts, feedback from nurses who use the DSTs, and approval by the CRNBC
Certified Practices Approval Committee.

Revisions to the following
Remote Nursing DSTs are effective immediately and are now posted on the CRNBC website. Be sure to replace previous versions of DSTs with the revised versions.

Rationale: Significant history elements for ceruminosis, signs of impaction, neurogenic stimulation of the vagus nerve may cause both findings, therefore value add to History specific to ceruminosis.

Physical Assessment:

Add new bullet: partial/complete obstruction of ear canal by cerumen.

Rationale: Patients may be symptomatic with either partial or complete obstruction, therefore value add.

Client Information and Discharge Education:

Expand 3rd bullet, adding the extension 'for ear hygiene' adds to applicability and uptake of the information for reader; cotton swabs may be used for other types of hygiene, added language to focus comprehension

Add new bullet: weekly irrigation…alcohol…

Rationale: This has been reported as an effective method to prevent cerumen build up, alternative recommendation for health education.

Rationale: alerts nurse to assess for the additional characteristics of hematemesis; it may present as either fresh blood [upper GI] or digested blood [lower GI] and the descriptors (red or coffee ground) allow for improved identification of pertinent signs of GI bleeding.

Incorporation into considerations for urine C&S:
this is suspected treatment failure

Using the term 'treatment failure' is a clinical descriptor for an unresolved infection where the client presents back with persistent symptoms, i.e. persistence of the UTI signs and symptoms related to the infection – it is not addressed by the criteria for Urine C&S currently in the DST content

Rationale: variable resistance and response patterns to standard therapy are noted in the literature. Given the scope of the DST a patient may return with treatment failure and require a C&S to receive appropriate subsequent antimicrobial therapy.

Rationale: spermicide use has been linked with UTIs; the proposed understanding is that the spermicides have varying impact on the normal bacterial of the vagina, leading to an overgrowth of bacteria that lead to infections. As such, detailed information on alternative contraception is of benefit to the target group of young sexually active women.